We will achieve this aim through the application of novel simulation-based training and assessment in an iterative process delivered to EDs through cycles of simulation-based assessment, training, assessment and repeat training.

The mobile simulation team will travel to EDs to provide “on-demand” evaluation and training. Our team will include a parent actor, a simulation technician, a pediatric ED physician educator and a pediatric nurse educator. Our team will be outfitted with multiple adjustable cameras and sensitive microphones to allow the scenario to be recorded digitally and played back for study review. Performance on these simulated cases will provide accurate and reliable assessments of the quality of pediatric emergency care in each department.

Participants in these simulations will include all ED staff in their work environment (paramedics, ancillary staff, nurses, and doctors).

After each simulation scenario providers will participate in post-performance debriefing. Experts in pediatric acute care will co-facilitate these debriefing sessions with a local “pediatric champion” identified by the ED director at each site. The debriefings will be recorded and provide rich qualitative data related to individual providers and the teams reflections on their performance. These recordings will identify strengths, deficiencies, and limits in pediatric specific knowledge, equipment, and expertise.

Participants will be encouraged to explore, analyze, and synthesize their actions and thought processes. Specific pediatric cognitive and technical objectives will be addressed, and a portion of time will also be spent analyzing the behavioral aspects of the resuscitation. Examples of topics that will be discussed include pediatric specific anatomy/physiology, family centered care, teamwork, communication, and how to access pediatric specialists at the regional Children’s Hospitals. Latent or system threats to safety will also be identified in the debriefing, for example, an institution may have a pediatric specific tool to measure oxygen in the blood stream, however it is imperative that the providers know where this piece of equipment is, how to use it, and how to interpret the values for a pediatric patient.

Subsequent to the sessions subject matter experts will conduct a more detailed blinded performance review on the video portal. Additionally our team will evaluate the presence of pediatric specific equipment, medications, staffing (pediatric competencies), practice guidelines and resources at each site. The Joint Policy Statement Guidelines for the Care of Children in the Emergency Department as developed by the American Academy of Pediatrics, American College of Emergency Physicians, and Emergency Nurses Association will be used as the framework for this evaluation.

Subject matter experts feedback and debriefings will be combined to develop a report with specific deficiencies, action items to address deficiencies (skills training, obtaining pediatric specific equipment, developing guidelines), and a timeline for these action items will be developed with the “pediatric champion” at each site as a follow-up of the simulation. Your EDs “pediatric champion” will work with our team to organize simulation sessions, develop action plans in response to the needs assessment.